<form autocomplete="off" class="layui-form layui-box" style='padding:25px 30px 20px 0' action="{:request()->url()}" data-auto="true" method="post">

    {notempty name="express"}
        <div class="layui-form-item">
            <label class="layui-form-label">物流公司</label>
            <div class="layui-input-block">
                <select required name="express" class="layui-select full-width">
                    {volist name="express" id="_express"}
                        <option value="{$_express.express_title}@{$_express.express_code}">{$_express.express_title}</option>
                    {/volist}
                </select>
            </div>
        </div>
    {/notempty}


    <div class="layui-form-item">
        <label class="layui-form-label">物流单号</label>
        <div class="layui-input-block">
            <input class="layui-input" required placeholder="请输入物流单号" title="请输入物流单号" name="send_no" />
        </div>
    </div>

    <div class="layui-form-item">
        <label class="layui-form-label">寄件人</label>
        <div class="layui-input-block">
            <input class="layui-input" required placeholder="请输入寄件人姓名" title="请输入寄件人姓名" name="send_username" />
        </div>
    </div>

    <div class="layui-form-item">
        <label class="layui-form-label">寄件人电话</label>
        <div class="layui-input-block">
            <input class="layui-input" required placeholder="请输入寄件人电话" title="请输入寄件人电话" name="send_phone" />
        </div>
    </div>

    <div class="layui-form-item">
        <label class="layui-form-label label-required">寄件省市区</label>
        <div class="layui-input-block">
            <div class='col-sm-2'>
                <select name="province" required="required" data-value="" lay-filter="province">
                    <option value="">请选择</option>
                </select>
            </div>
            <div class='col-sm-2'>
                <select name="city" data-value="" lay-filter="city">
                    <option value="">请选择</option>
                </select>
            </div>
            <div class='col-sm-2'>
                <select name="district" data-value="" lay-filter="district">
                    <option value="">请选择</option>
                </select>
            </div>
        </div>
    </div>

    <div class="layui-form-item">
        <label class="layui-form-label">寄件人详细地址</label>
        <div class="layui-input-block">
            <textarea required placeholder="请输入详细地址" title="请输入详细地址" name="send_address" class="layui-textarea">{$send_address|default=""}</textarea>
        </div>
    </div>

    <div class="layui-form-item">
        <label class="layui-form-label">备注</label>
        <div class="layui-input-block">
            <textarea required placeholder="请输入备注" title="请输入备注" name="express_desc" class="layui-textarea">{$desc|default=""}</textarea>
        </div>
    </div>

    <div class="hr-line-dashed"></div>

    <div class="layui-form-item text-center">
        {if isset($order_no)}<input type='hidden' value='{$order_no}' name='order_no'>{/if}
        <button class="layui-btn" type='submit'>保存数据</button>
        <button class="layui-btn layui-btn-danger" type='button' data-confirm="确定要取消编辑吗？" data-close>取消编辑</button>
    </div>

</form>
{block name='script'}
<script src="__STATIC__/citylist2.js"></script>
{/block}